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Cagney Healthcare of Illinois, Inc.
INDIVIDUAL AND FAMILY EVIDENCE OF COVERAGE
Cagney Connect 2800
THIS EVIDENCE OF COVERAGE MAY NOT APPLY WHEN YOU HAVE A CLAIM! PLEASE READ!
This Evidence of Coverage
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What is il-cigna-connect-2800-mihm0240-0241?
It is an annual health insurance enrollment form.
Who is required to file il-cigna-connect-2800-mihm0240-0241?
Employees who are eligible for health insurance benefits.
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The form must be completed with personal and dependent information.
What is the purpose of il-cigna-connect-2800-mihm0240-0241?
To enroll in or make changes to health insurance coverage.
What information must be reported on il-cigna-connect-2800-mihm0240-0241?
Employee and dependent personal information, coverage selection, and any changes.
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